MEDICARE: JOHN CALABRESE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN1858608	MA

General Provider Information

NPI Number	:	1851956668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CALABRESE

Provider Business Mailing Address
First Line	:	64 HIGH MEADOW DR
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-1663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 N MAIN ST STE A
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1834
Country	:	US
Telephone Number	:	413-224-1493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/05/2020

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Directions to “ JOHN CALABRESE ” Practice Location

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